State details request for $10 billion Medicaid waiver

State officials formally submitted a request to keep $10 billion that recent changes to the Medicaid program have saved the federal government, saying investing that money over the next five years will further “bend the Medicaid cost curve.”

The entire waiver request is below. Changes to the ballooning Medicaid system — which is jointly funded by the federal, state and county governments — were implemented in the last two state budgets and have wrung $34 billion in projected spending over the next five years.

Spending increases were capped at four percent, and to cut costs, officials are directing more dollars to primary care — a cheaper alternative to hospital care. The federal share of that savings is $17 billion, and the waiver — which officials have been talking about for months — would keep a majority of those dollars flowing to the state.

— $500 million for “medical home” programs that coordinate care among facilities for patients with chronic conditions. There are 34 such programs already operating in the state, but Health Commissioner Nirav Shah said the money will help “build to scale.”

— Just over $1.7 billion would go to hospitals in poor communities — some of which are under water. These facilities service a high rate of Medicaid patients. Just over $1 billion of this money will be used for “balance sheet restructuring,” which will help hospitals pay off debt and invest in emerging areas of care.

— There’s $20 million for water fluoridation.

— Starting in 2014, the state hopes to spend $125 million a year for recruitment, retention and retraining of staff. That’s a total of $500 million.

Introne and Shah said they hoped the federal government would evaluate and approve the waiver before the state’s fiscal year ends in March.